Basic Information
| Provider Information | |||||||||
| NPI: | 1124055082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDRA | ||||||||
| FirstName: | NAMARTA | ||||||||
| MiddleName: | AWASTHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE STREET SE, MMC 292 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263345 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1D | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122730622 | ||||||||
| FaxNumber: | 6122732696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 41453 | MN | X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 41453 | MN | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 16-02032 | 01 | MN | MEDICA PRIMARY | OTHER | 32602400 | 05 | WI | MEDICAID | 0540666 | 05 | IA | MEDICAID | 01021655 | 01 | MN | PREFERRED ONE | OTHER | 44R95CH | 01 | MN | BCBS | OTHER | HP38513 | 01 | MN | HEALTHPARTNERS | OTHER | 123842 | 01 | MN | UCARE | OTHER | 16-00419 | 01 | MN | MEDICA CHOICE | OTHER | 10387 | 05 | ND | MEDICAID | 866695 | 01 | MN | ARAZ | OTHER |